Taking a person's liberty away is a major constitutional act. We are advised that we G.Ps. must have a good knowledge of the relevant law and carry out procedures to the letter of the law.

However, the 1945 Act is unworkable in many circumstances. "Persons of unsound mind," (P.U.M.) to whom the Act mainly refers, are nowadays rare due to modern medication. "Temporary patients" are outside the remit of Garda escort.

The patient, who is the doctor's prime concern, must not be committed unless there is real need and sufficient clinical indication.

There are actions G.Ps. are not rerquired to do under the Act, including actions which may be illegal and leave them liable to be sued:

• Arranging transport under the Mental Treatment Act 1945 (either of two sources are responsible for conveying the subject of a detention order to hospital, the Applicant and/or the Mental Hospital Authority maintaining the mental hospital mentioned in the application).
• Providing an escort.
• Telephoning the hospital or taking the patient to hospital.
• Treating the patient without the patient's explicit and unforced consent.
• Filling in both pink and white forms. (The white form relates to persons of unsound mind (P.U.M.) requiring greater than six months detention). This would be grossly improper.

Garda Powers

1. If a person is a danger to himself or to others the Gardai have powrs to restrain him and detain him.
2. On request by the applicant, with an additional certificate from the doctor, the Gardai may escort a P.U.M.
3. The Gardai have no power to escort a temporary patient.
4. A P.U.M. may not be detained in a General Hospital.

Strong Advice

1. Do not sign a white (P.U.M.) form unless you have firm grounds to believe the patient will need to be in hospital for more than six months.
2. Especially do not sign a pink form to recommend committal and then a white form (to be torn up at the hospital) merely to ensure escort by the Gardai. This is grossly irregular and could cost you dearly if not, in fact, have you put in gaol.

G.Ps. Actions

1. Adequately examine the patient on request and form an opinion.
2. On proper application, fill in the section on the form (pink almost always) recommending or not that the patient needs to be temporarily (less than six months) committed.
3. Remember, the patient is your prime concern and may need other clinical care and advice.
4. You may rarely need to call an urgent case conference with the Garda Superintendent, psychiatrist, community social worker, etc.
5. It may be wise sometimes to share the burden with a colleaque or telephone the A.G.P. for advice.

What The G.P. Must Not Do

1. Do not administer any treatment without consent .
2. Do not have a supply of forms.
3. Do not fill in the applicant's selection.
4. Do not work the unworkable or the illegal.
5. forget the Gardai have powers to restrain and arrest persons who are dangers to themselves or others.

The Applican's Part

1. The applicant, usually the spouse, obtains an application from the Gardai, Solicitor or Health Board (G.Ps. need to take extra care in case of marital discord; remember the patient is the most important person).
2. The applicant must present a properly filled in and signed application before the G.P. can properly act.
3. The applicant arranges transport - not the G.P.
4. It is up to the applicant to arrange transfer to hospital of the patient, and to advice the patient of his right to a secongd opinion if transfer is made before the admitting psychiatrists signs the committal order.

What G.Ps. Want In The New Mental Treatment Act

1. Protection of the G.P. by the presence of Gardai when necessary.
2. The presence of a psychiatrist if necessary.
3. Access to legal advice if necessary.
4. Assurance that life and accident insurance are not renderes invalid by voluntarily entering dangerous situations.
5. Compensation to the doctor or his family in case of injury or death (as for hospital staff).
6. A proper fee.
7. Circumstances to be outlined in which treatment can be administered without the patient's permission.

Postscripts

Unless a G.P. is certain that committal is necessary he/she would be advised to have a psychiatrist assess the patient. There should be a formal consultation with written records. Consultant psychiatrist's opinion should always be obtained in writing in cases of addiction to any substance before a recommendation to commit is decided on.

Our advice may seem impractical in an urgent situation. However, being "practical" and enabling has caused G.Ps. to be left in vulnerable and sometimes dangerous situations.

The above guidelines may leave the applicants, Gardai and Health Boards in a difficulty. An Act of the Oireachtas is required. Occasionally, due to legislators' neglect, G.Ps. are unable to help and we have to accept this.

The Health Board through the psychiatric services have the responsibility to provide the appropriate services. In cases of dangerous emergency the Gardai have power to restrain and arrest.

The minimum recommended fee is £130.00 with up to £250.00 to be claimed in cases of danger, lengthy time involved or out of hours.

The strategy is to find cases, however few, where the patient will not suffer when the G.P. acts strictly according to the law, i.e. works to rule, harming nobody, but putting pressure on the State to rectify various faults in the Mental Treatment Act.

Don't forget 50% of G.Ps. (on evidence gathered at meetings over the past year) have been terrorised, assaulted or sued.

Before 1945 a court order had to be obtained to commit a patient.

When requested for an opinion the G.P should firstly ascertain whether the patient is:

Violent	Non Violent
Visit with Garda protection	Visit
Examine the patient and form an opinion
If necessary to recommend committal	Not necessary to recommend committal
Advise applicant to present a properly filed-in application to the G.P. It is best that a Solicitor would provide this application form and give necessary advice to the applicant.	Offer appropriate advice and treatment to the patient.
Sign the application form (pink) recommending committal for a period not exceeding six months.
Send in free claim to the Health Board

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